Background and aims: Ulcerative colitis (UC) is an acute and chronic inflamma tory disease of the large bowel with unknown aetiology. The immune response agai nst normal commensal microorganisms is believed to drive i...Background and aims: Ulcerative colitis (UC) is an acute and chronic inflamma tory disease of the large bowel with unknown aetiology. The immune response agai nst normal commensal microorganisms is believed to drive inflammatory processes associated with UC. Therefore, modulation of bacterial communities on the gut mu cosa, through the use of probiotics and prebiotics, may be used to modify the di sease state. Methods: A synbiotic was developed for use in UC patients combining a probiotic, Bifidobacterium longum, isolated from healthy rectal epithelium, a nd a prebiotic (Synergy 1), a preferential inulinoligofructose growth substrate for the probiotic strain. Treatment was employed in a double blinded randomised controlled trial using 18 patients with active UC for a period of one month. Clinical status w as scored and rectal biopsies were collected before and after treatment, and tra nscription levels of epithelium related immune markers were measured. Results: S igmoidoscopy scores (scale 0- 6)were reduced in the test group (start 4.5 (1.4) , end 3.1 (2.5)) compared with placebo (start 2.6 (2.1), end 3.2 (2.2)) (p=0.06) . mRNA levels for human beta defensins 2, 3, and 4, which are strongly upregulat ed in active UC, were significantly reduced in the test group after treatment (p = 0.016, 0.038, and 0.008, respectively). Tumour necrosis factor α and interl eukin 1α , which are inflammatory cytokines that drive inflammation and induce defensin expression, were also significantly reduced after treatment (p = 0.018 and 0.023, respectively). Biopsies in the test group had reduced inflammation an d regeneration of epithelial tissue. Conclusions: Short term synbiotic treatment of active UC resulted in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy.展开更多
Introduction: Functional abdominal symptoms are very common and account for nearly two million primary care consultations in Britain every year and produce significant morbidity. The aims of this study were to evaluat...Introduction: Functional abdominal symptoms are very common and account for nearly two million primary care consultations in Britain every year and produce significant morbidity. The aims of this study were to evaluate the impact of two self-help interventions on consultation rates and symptom severity in patients with a primary care diagnosis of irritable bowel syndrome. Methods: A total of 420 patients from 54 primary care centres were randomised either to receive self-help information in the form of a guidebook or the guidebook plus a “self-help" group meeting or to be in a control group receiving neither intervention. Data were collected using questionnaires and primary care records. Results: At one year, patients in the guidebook group had a 60%reduction in primary care consultations (p < 0.001) and a reduction in perceived symptom severity (p < 0.001) compared with controls. Allocation to the self-help group conferred no additional benefit. Actual symptom scores did not change significantly in any group. Costs per patient were reduced by ￡73 (confidence interval ￡43, ￡103) or 40%per year. Conclusion: Introduction of a self-help guidebook results in a reduction in primary care consultations, a perceived reduction in symptoms, and significant health service savings. This suggests that patients attending their primary care physician with functional abdominal symptoms should be offered self-help information as part of their management.展开更多
文摘Background and aims: Ulcerative colitis (UC) is an acute and chronic inflamma tory disease of the large bowel with unknown aetiology. The immune response agai nst normal commensal microorganisms is believed to drive inflammatory processes associated with UC. Therefore, modulation of bacterial communities on the gut mu cosa, through the use of probiotics and prebiotics, may be used to modify the di sease state. Methods: A synbiotic was developed for use in UC patients combining a probiotic, Bifidobacterium longum, isolated from healthy rectal epithelium, a nd a prebiotic (Synergy 1), a preferential inulinoligofructose growth substrate for the probiotic strain. Treatment was employed in a double blinded randomised controlled trial using 18 patients with active UC for a period of one month. Clinical status w as scored and rectal biopsies were collected before and after treatment, and tra nscription levels of epithelium related immune markers were measured. Results: S igmoidoscopy scores (scale 0- 6)were reduced in the test group (start 4.5 (1.4) , end 3.1 (2.5)) compared with placebo (start 2.6 (2.1), end 3.2 (2.2)) (p=0.06) . mRNA levels for human beta defensins 2, 3, and 4, which are strongly upregulat ed in active UC, were significantly reduced in the test group after treatment (p = 0.016, 0.038, and 0.008, respectively). Tumour necrosis factor α and interl eukin 1α , which are inflammatory cytokines that drive inflammation and induce defensin expression, were also significantly reduced after treatment (p = 0.018 and 0.023, respectively). Biopsies in the test group had reduced inflammation an d regeneration of epithelial tissue. Conclusions: Short term synbiotic treatment of active UC resulted in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy.
文摘Introduction: Functional abdominal symptoms are very common and account for nearly two million primary care consultations in Britain every year and produce significant morbidity. The aims of this study were to evaluate the impact of two self-help interventions on consultation rates and symptom severity in patients with a primary care diagnosis of irritable bowel syndrome. Methods: A total of 420 patients from 54 primary care centres were randomised either to receive self-help information in the form of a guidebook or the guidebook plus a “self-help" group meeting or to be in a control group receiving neither intervention. Data were collected using questionnaires and primary care records. Results: At one year, patients in the guidebook group had a 60%reduction in primary care consultations (p < 0.001) and a reduction in perceived symptom severity (p < 0.001) compared with controls. Allocation to the self-help group conferred no additional benefit. Actual symptom scores did not change significantly in any group. Costs per patient were reduced by ￡73 (confidence interval ￡43, ￡103) or 40%per year. Conclusion: Introduction of a self-help guidebook results in a reduction in primary care consultations, a perceived reduction in symptoms, and significant health service savings. This suggests that patients attending their primary care physician with functional abdominal symptoms should be offered self-help information as part of their management.
